WebSpecific ACORD 38s are available for applicants in these states.) (Applicant's Initials): PERSONAL INFORMATION ABOUT YOU, INCLUDING INFORMATION FROM A CREDIT OR OTHER INVESTIGATIVE REPORT, MAY BE COLLECTED FROM PERSONS OTHER THAN YOU IN CONNECTION WITH THIS APPLICATION FOR INSURANCE AND … WebACORD 131 (2016/04) SIGNATURE Applicable in PR: Any person who knowingly and with the intention of defrauding presents false information in an insurance application, or presents, helps, or causes the presentation of a fraudulent claim for the payment of a loss or any other benefit, or presents more than one claim for the same damage or loss,
EVIDENCE OF PROPERTY INSURANCE
Webacord 147 (2016/03) page 2 of 3 attach to acord 125 agency customer id: insured's job number: job description describe the work to be performed specific job causes of loss & deductible causes of loss sub limit deductible earthquake $ flood $ $ broad basic special coverage $ location limit at a temporary $ transit limit $ limit at location job ... Web(If "YES", attach ACORD 815 for Liability Exposure and/or ACORD 816 for Property Exposure) 12. AGENCY CUSTOMER ID: (Not applicable in AZ, CA, DE, KS, MA, MN, ND, NY, OR, VA, or WV. Specific ACORD 38s are available for applicants in these states.) (Applicant's Initials): hulkout 1 death in the family
ACORD EVIDENCE OF PROPERTY INSURANCE DATE
Webthe acord name and logo are registered marks of acord approved by named insured policy number carrier naic code fax (a/c, no): agency name: contact (a/c, no, ext): phone code: subcode: agency customer id: address: e-mail statement of no loss cancellation date date and time signed from 12:01 am on to . the insurance policy whose number is shown ... Web(If "YES", attach ACORD 815 for Liability Exposure and/or ACORD 816 for Property Exposure) 12. AGENCY CUSTOMER ID: ACORD 125 (2016/03) Page 3 of 4 OCCUR DATE EXPLANATION RESOLUTION RESOLVE DATE OCCUR DATE EXPLANATION RESOLUTION RESOLVE DATE 14. DOES APPLICANT OWN / LEASE / OPERATE … WebOTHER COVERAGES, RESTRICTIONS AND/OR ENDORSEMENTS (For hired/non-owned auto coverages attach the applicable state Business Auto Section, ACORD 137) IMPORTANT - If CLAIMS MADE is checked in the COVERAGE / LIMITS section below, this is an application for a claims-made policy. Read all provisions of the policy carefully. … holiday music in abilene texas